1. Field of the Invention
The present invention relates generally to systems and methods for electronic data interchange, and more particularly to systems and methods for data monitoring and data authentication. Still more particularly, the present invention is a system and method for secure medical and dental record interchange.
2. Description of the Background Art
When a medical professional such as a doctor or a dentist performs services related to a given patient, a record that includes medical or dental information, respectively, associated with the patient is generated. This medical information can include one or more X-rays, dental charts, treatment plans, clinical notes, or other information. Generally, the medical professional, or provider, must send a claim to an insurance company or other medical claim payment authority for a review. As a part of the review, the provider may be required to send supporting medical information associated with the claim to the medical claim payment authority. During the review, the medical claim payment authority may attempt to determine the condition of the patient and whether a proposed or undertaken treatment is appropriate. Based upon the review, the medical claim payment authority may or may not authorize payment for the associated medical services. In the event that the claim is sent to a Health Maintenance Organization (HMO), the aforementioned review is typically performed prior to the authorization of a proposed treatment.
The use of electronic systems and methods, and in particular computer systems and computer-based methods, for the generation, acquisition, and storage of medical information is becoming increasingly common. For example, digital X-ray devices are often used to generate digital X-ray images. As another example, a digital image representing nearly any type of document or picture can be generated via a scanning device. After a digital image has been generated or acquired, the image can be stored on a computer system's hard disk drive or optical disk drive. As yet another example, clinical notes or treatment recommendations can be entered via a word processing program and stored within a data file. The use of computer systems and computer-based methods for medical and dental claim processing is highly desirable because such systems and methods offer the promise of reduced claim processing costs and near-real-time claim review.
Associated with each piece of medical information sent to a medical claim payment authority is a risk of fraud. In particular, the medical claim payment authority may have no indication whether one or more portions of a given patient's medical information have been altered, or whether the medical information that has been submitted actually corresponds to the indicated patient. The use of computer systems and computer-based methods for generating, storing, and transmitting medical information increases the risk of fraud because digital data can be easily manipulated, modified, or copied. In the prior art, no system or method exists for reducing the risk of fraud when medical or dental information is generated or acquired electronically.
In data processing applications, systems and methods for the prevention of fraud fall within the topic of data security. What is needed is a means for medical and dental record interchange that reduces the risk of fraud when medical and dental information is generated, acquired, or transmitted electronically.